Taking SSRIs (selective serotonin re-uptake inhibitor medications like Prozac, Zoloft, Celexa) during pregnancy is still a somewhat controversial issue. However, I think it is critical to remember that we now know that untreated depression in pregnancy is also risky to the growing fetus and to the mother as well. Depression in pregnancy has been shown to be a cause of low birth weight, preterm labor, and small size babies. The longer you stay depressed, the harder it may be to recover, and the longer you stay depressed, the more at risk you are for future episodes of depression. Moms with depression in pregnancy are at a very high risk of depression postpartum. Unfortunately, there are risks with or without medication. I think the question is, what is the best choice for you and your baby?
In my mind, depression must be treated. Suffering won’t help you or the growing baby. There are some non-medication treatments that may be helpful. In one small study, omega-3 fatty acids helped depressed pregnant moms. You can read more about omega-3’s on my website.
In other studies, bright morning light (simulated with special light boxes, emitting 10,000 lux) helped depression in pregnant women. Interpersonal group therapy helped depressed pregnant women in another small study. Interpersonal or Cognitive Behavioral therapy can also be helpful.
What do we know about medications at this point? In a study of women who stopped their antidepressants, 90% became depressed by the second trimester. Last year, the New England Journal of Medicine printed two articles reviewing the safety of SSRIs during pregnancy. When we think about the risks of medication, we need to remember first that even non-medicated, “normal” pregnancies carry a risk of miscarriage, and a small risk of birth defects. Both studies of SSRI’s in pregnancy found defects were rare, and the overall increased risk was small.
Your husband’s concern about long-term effects is important to acknowledge. Studies looking at children who were exposed to SSRIs in pregnancy have been done up to 5-1/2 years of age. No IQ or neurobehavioral differences were found in these kids compared to non-exposed kids. Several years ago, I had the opportunity to chat with one of the lead researchers of that study and I asked if she had continued to follow these children to make sure nothing showed up as they aged. She is from Canada where their healthcare system is different from ours here in the US. She laughed at me, and assured me that if there had been a problem, there would have been a lawsuit in the United States. I have to admit, she was right. To this day, I do not believe there have been any legal cases or reports related to a bad long-term outcome from SSRIs taken while pregnant. This researcher also felt that if there were long-term consequences, they would have shown up by now. Prozac, which has been tested the most in pregnancy, has been around for many years.
One other thing to consider is the effect of your depression on your first child. Maternal depression is known to cause long term negative effects on children, including poor school readiness. Kids need a parent who is upbeat, positive, and patient. Depression usually steals those qualities away. This is also challenging for relationships as well.
I think it would be helpful to find a therapist or psychiatrist trained in pregnancy and postpartum mood disorders to talk with you and your husband. Don’t forget that each child comes out of the womb different and unique.
You will need to be at peace with your decision. It won’t help to say, “Oh, she’s crying because I did take meds, or because I didn’t.”
There are some websites that have a lot of information about depression in pregnancy and postpartum. Several can also help you locate a trained professional.
www.postpartum.net
www.mededppd.org
womensmentalhealth.org
Some good books on the subject are Pregnancy Blues by Shaila Misri MD and Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression by Shoshana Bennett and Pec Indman.
I normally take an SSRI (anti-depressant), but my paranoid husband asked me to stay off of them for my first pregnancy. I was absolutely miserable. Now that we are trying to get pregnant again, Im afraid to go through another pregnancy like my last one. But what if my husbands right and the medication ends up harming the baby?
